ILDR 615 Change Initiative Paper
The dynamism of the healthcare industry and the complexity of the same makes it
inevitable for change to occur in healthcare settings. In order to effect change, healthcare
organizations will adopt the usage of varied healthcare models as standalones or in combination.
Mahmood (2018) observes that whereas numerous models of change exist, the healthcare field
has only applied four of them namely Kotter’s Model, Lewin’s Model, Balanced Scorecard, and
Gannt Charts. These change models play an effective role in reducing the rate of nurse turnovers
such as the one witnessed at the University of Texas Medical Branch Medical-Surgical floor.
The adoption of leadership strategies such as effective staffing ratios and enhanced interpersonal
relationship based on the Lewin’s Model of Change at the University of Texas Medical Branch’s
floor nursing will be foundational to the present paper. The Lewin’s Change Model entails the
usage of freezing, change and unfreezing that will inform the current project.
Culture and Behavior at The University of Texas Medical Branch
The UTMB facility predominantly has a change management culture within its
operations. The phenomenon has ensured that the facility constantly renews its capabilities,
direction and structure so as to serve the dynamic needs of the internal and external driving
forces that influence organizational success (Hussein et al., 2018). Moreover, the facility always
favors the adoption of evidence-based practice to address some of the challenges facing
healthcare including leadership issues such as the retention of nurses.
The UTMB facility also does not give priority to the status quo of the facility. Hussein et
al. (2018) assert that the presence of status quo preference forms a bottleneck to the initiation and
eventual implementation of change initiatives. Therefore, the presence of a contrary behavior at
CHANGE INITIATIVE PAPER 3
the UTMB facility makes it amenable to any change initiative regarding any issue that may be
affecting the facility such as the high rate of nurse turnover at its floor area.
Methods to Evaluate the Need for Change
The need for change as regards nurse retention and the leadership role at the UTMB will
depend on a host of parameters. Both internal and external factors will play a crucial role in
demonstrating that the leadership need to address the high rate of floor nursing staff turnover.
Internal factors such as nurse burnout, failing quality indicators, increased patient readmission
rates, and higher patient mortality indicate the impact of nurse turnover on the quality of services
offered by the hospital. According to Halter et al. (2017), the presence of such internal factors
play fundamental roles in determining the need for change. As a consequence, a need exists to
address the issue of nurse turnover at the UTMB to ensure that the quality indicators as discussed
above remain high.
External factors also reveal important information concerning the need for change in a
healthcare facility. The UTMB hospital has registered failing patronage over the last couple of
years due to the reduced internal quality factors discussed above. Further, statistics reveal that
the rate of patient satisfaction has failed at the facility, which indicates the need to address the
causative factors. Most importantly, the generation of revenue at the hospital has reduced by a
fifth. Hughes (2017) argues that failing profits at a healthcare facility forms one of the most
important indicators concerning the need for change. Thus, the fact that it coincides with the
issue of increased nurse turnover implies that it has a direct impact on the same.
Choosing Individuals/Teams Necessary for Change
CHANGE INITIATIVE PAPER 4
The evaluation of the need for change has revealed that the UTMB needs to formulate a
team to oversee the change regarding the issue of nurse turnovers. To this, end making a choice
concerning change agents becomes an important facet of the change process. The individual that
will oversee the change process will need to have certain aspects. Indeed, the success of any
change process heavily depends on the workability and quality of the change agent and
influential decision makers within a facility (Zbieg, Batorski, & Żak, 2016). As such, the change
agents for the nurse turnover reduction initiative at the UTMB facility will need to have qualities
that facilitate the above.
The nurse managers will play the frontline role in ensuring the implementation of the
enhanced interpersonal relationship and reduced nurse-to-patient ratios. To achieve this
objective, the managers will have to possess micro and macro-perspectives. Moreover, they
should have the ability to respect eternal standards and own beliefs. The change agents will need
proactivity to effectively induce the change. The change agents for the project will also need to
have empathy for the floor nurses to implement the required measures appropriately (Kodama &
Fukahori, 2017). A confluence of the characteristics necessary for the change agents or teams
will ensure that interpersonal relationships and reduction of staff-to-nurse ratio interventions
become effectively implemented at the UTMB.
The effectiveness of a change initiative will depend on the type of communication
adopted by an organization. Given that the objective entails creating an interpersonal relationship
between the leaders and the nurses, UTMB will adopt an informal communication strategy. The
CHANGE INITIATIVE PAPER 5
usage of this strategy occurs so as to leverage on the informal social paths, connection, and
dependencies to enhance interprofessional associations between nurses and the leadership of
UMBT (Zbieg, Batorski, & Żak, 2016). Further, the decision to choose the informal
communication receives inspiration from the fact that it acts as a reliable proxy for the roles that
employees plan in a company.
Moreover, the UTMB will also adopt the formal communication strategies including to
pass certain messages. The diffusion of the information to the entire company will occur based
on cascade communication. The organization already prepared itself for widespread change
concerning retention of floor nurses. As such, a group of managers will train a lower and larger
cadre of employees, who in turn pass the information to their colleagues. Zbieg, Batorski, and
Żak (2016) posit that the training on the organizational vision and value of the company and the
important role that floor nurses play will make them feel valued and want to remain with UTMB.
Strategies to Gather Stakeholder Support and Overcome Resistance
The process of change occurs based on the support received from stakeholders. However,
the complexities of certain change lead to the existence of stakeholder intransigence. The
inclusion of stakeholders in change initiatives has numerous values such as feelings of common
value, satisfaction, trust, and commitment (Pandi-Perumal et al., 2015). Making the floor nurses
and their managers to feel needed forms one of the most important strategies that will make them
support the project. Secondly, it becomes important to define the vision processes of the change
that would see nurse the hospital leadership improve their interpersonal processes with the floor
nurses. The explanations offered concerning the visions of the hospital and how the nurses
influence that will make them feel valued hence offer support to the project.
CHANGE INITIATIVE PAPER 6
The process of overcoming stakeholder resistance will also depend on explanations
offered concerning the benefits of the process. The UTMB leadership will have to maintain a
positive association with stakeholders and communicate with them throughout the entirety of the
project (Pandi-Perumal et al., 2015). Further, undertaking continuous interactions with the
stakeholders and answering their reservations will play a fundamental role.
The implementation of the proper interpersonal relationships will play an important role
in ensuring that nurses become satisfied with their environment. The issue of nurse turnover rate
occurs at the start of the nursing career when the leadership does not explain to nurses their roles
and their impact on the quality of services. Thus, in order to improve the retention of nurses, the
leadership of the floor nurses will conduct job—interviews with the nurses so as to create a
positive impression (Lapeña-Moñux, Cibanal-Juan, Pedraz-Marcos, & Macía-Soler, 2014).
Moreover, the nurse leaderships should create proper and effective interpersonal relationships
with the floor nurses. Such an approach will allow the floor nurses at the UTMB to express their
problems to the management and offer solutions as to how the leadership can address them.
Therefore, the strategies lead to the existence of positive relational skills and attitudes, which
lead to improved job satisfaction and reduced occupational stress.
The sustainability of a change initiative becomes important in the change initiative in
healthcare. The very first step in the process entails the identification of the threats to a project at
its start and when ready for execution. The UTMB will achieve above via the usage of The
CHANGE INITIATIVE PAPER 7
National Health Service Sustainability Model, which identifies the long-term excellence of the
project (Silver et al., 2016). The identification will follow be followed by the adoption of tools
such as process control boards, improvement hurdles, performance board and standard work. The
UMBT will use the above tools to ensure the sustainability of the project.
The performance boards and process control form methodologies used to communicate
the improvement outcomes to the leadership and staff. The standard work forms a visual or
written outline of the contemporary best practices for the nurses’ floor roles and offers a
framework to ensure that they follow positive practices in a consistent manner (Silver et al.,
2016). The improvement hurdles on the other hand entails short, regular meetings between the
staff and the leadership at UTMB that will anticipate issues, assess performance and then support
an improvement culture of the existing relationships between them.
The Kurt Lewin’s Change Model Concept Map
Kurt Lewin’s Model
The relationship between nurses and
leadership at the UTMB has been poor
leading to high rates of nurse turnover at
the floor section
The UTMB registers nurse burnout,
failing quality indicators, increased
patient readmission rates, and higher
patient mortality indicate the impact of
nurse turnover on the quality of services
offered by the hospital
Change agents at UTMB will need to
have micro and macro-perspectives,
ability to respect eternal standards and
own beliefs, be proactive, and have
empathy for floor nurses
The leadership will use informal
communications to ensure that
interpersonal relationship is achieved.
The usage of this strategy occurs so as
to leverage on the informal social
paths, connection, and dependencies to
enhance interprofessional associations
between nurses and the leadership of
Formal communication channels such
as cascade communication and emails
will be adopted to pass information
Stakeholder involvement will entails
strategies such as making the floor
nurses feel needed, defining the vision
processes of change, and defining the
benefits of the change initiative
The implementation of the
process will begin at the start of a
nurse’s career to create a
relationship between them and
Creating proper interpersonal
relationships through strategies such
as information meetings also
contributes to the creation of an
interpersonal relationship between
the floor nurses and the leadership
The sustainability of the project will
entail the adoption of processes such
as The National Health Service
Sustainability Model, performance
boards and process control, and the
CHANGE INITIATIVE PAPER 8
Mahmood, T. (2018). What models of change can be used to implement change in postgraduate
medical education?. Advances in medical education and practice, 9, 175. Retrieved from
Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin's
change model: A critical review of the role of leadership and employee involvement in
organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. Retrieved
Halter, M., Pelone, F., Boiko, O., Beighton, C., Harris, R., Gale, J., … & Drennan, V. (2017).
Interventions to reduce adult nursing turnover: A systematic review of systematic
reviews. The open nursing journal, 11, 108.
Hughes, V. (2017). Leadership strategies to promote nurse retention. Sci J Nurs Pract, 1(1), 1-5.
Zbieg, A., Batorski, D., & Żak, B. (2016). How to Select Change Agents in Organizations? A
Comparison of the Classical and Network Approaches. Problemy Zarządzania, (4/2016
(64), t. 2), 120-143.
Kodama, Y., & Fukahori, H. (2017). Nurse managers' attributes to promote change in their
wards: a qualitative study. Nursing open, 4(4), 209–217. https://doi.org/10.1002/nop2.87
CHANGE INITIATIVE PAPER 9
Pandi-Perumal, S. R., Akhter, S., Zizi, F., Jean-Louis, G., Ramasubramanian, C., Edward
Freeman, R., & Narasimhan, M. (2015). Project stakeholder management in the clinical
research environment: How to do it right. Frontiers in psychiatry, 6, 71.
Lapeña-Moñux, Y. R., Cibanal-Juan, L., Pedraz-Marcos, A., & Macía-Soler, M. (2014).
Interpersonal relationships among hospital nurses and the use of communication skills.
Texto & Contexto-Enfermagem, 23(3), 555-562.
Silver, S. A., McQuillan, R., Harel, Z., Weizman, A. V., Thomas, A., Nesrallah, G., … &
Chertow, G. M. (2016). How to sustain change and support continuous quality
improvement. Clinical Journal of the American Society of Nephrology, 11(5), 916-924.